Although there are effective treatments available to reduce the risk of fracture in patients with osteoporosis, their routine use in all patients at risk is neither clinically nor financially feasible. Resources must be targeted to those patients who are likely to benefit most from treatment.
Census data from 2001 for the United Kingdom were reviewed. All women 65 years of age or older who were living at home and registered with a general practitioner in Coatbridge, Scotland (n=4045) were mailed a questionnaire regarding osteoporosis. Women who reported a history of fracture and had never been screened for osteoporosis were invited for bone mineral density (BMD) testing at the lumbar spine and hip by dual-energy X-ray absorptiometry (DXA). Treatment was prescribed based on UK guidelines for management of osteoporosis. An additional group of women who were referred for BMD testing by their local practitioners because of risk factors for osteoporosis also had DXA testing.
Overall in this study, BMD testing was performed on 1054 women. Among women with a history of fracture (n=591), 307 (51.9%) had osteoporosis; 204 (34.5%) had osteopenia; only 80 (13.5%) had normal BMD. Among women with no history of fracture but with osteoporosis risk factors (n=463), 159 (34.3%) had osteoporosis; 211 (45.6%) had osteopenia; 93 (20.1%) had normal BMD. None of these women had received treatment for osteopenia/osteoporosis prior to this evaluation. On the basis of test results and clinical review, treatment was prescribed, according to protocol, for 433 women who had a history of fracture (413 [95.4%] received calcium, vitamin D, and bisphosphonate; 20 [4.6%] received calcium and vitamin D) and for 237 women with risk factors (190 [80.2%] received calcium, vitamin D, and bisphosphonate; 47 [19.8%] received calcium and vitamin D).
Fractures are relatively common in older women, but treatment rates are low. Previous fracture was confirmed in this audit as a strong predictor of osteoporosis. This case-finding strategy can be used in primary care to identify high-risk patients, to ensure appropriate prescribing, to implement national guidelines for osteoporosis management, and to improve care of patients with prior fragility fracture.
Disclosure Information:
Faculty Member's Name: Eamonn Brankin, MB, ChB, MSc
Grants/Research Support: Merck
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